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PubMed2000

The continuing risk of domestic hot water scalds to the elderly.

Elderly people are particularly at risk of accidents in the home and with an ageing population, they constitute a large proportion of scald victims. We have seen several elderly patients every year in our own unit who had sustained domestic hot water burns. We decided to ascertain the temperature of water in the private homes of elderly people and in residential care homes in our community. Twenty-five private homes and 14 residential care homes were visited and peak water temperatures were measured in the kitchens and bathrooms. Only one private home and one residential home had water below 45 degrees C. It is recommended that water should be delivered at less than 43 degrees C. We conclude that water is dangerously hot. However, if water is stored at a temperature of less than 60 degrees C there is a risk of infection with Legionella pneumophila. Existing regulations governing the use of 'fail safe' thermostatic mixing devices must be enforced and extended to cover domestic hot water systems.

Accidents, Home↗

PubMed2002

The performance and potential of faecal separation and urine diversion to recycle plant nutrients in household wastewater.

In household wastewater and biodegradable solid waste, the main proportion of the plant nutrients are found in the toilet water (i.e. in urine and faeces). In order to recover most of these nutrients, with the purpose of decreasing the emission of eutrophicating agents and of increasing their recycling, present waste and wastewater systems have to be changed. If the urine and the faeces are collected, up to 91%, 83%, and 59% for N, P and K, respectively, can be recovered and recycled from the household wastewater. The urine was collected separately in a double flushed urine-diverting toilet and the faeces were separated from the flushwater using two parallel Aquatrons. The Aquatron separates by a combination of a whirlpool effect, gravitation and surface tension. In this study, nitrogen and phosphorus from the faeces were separated to 73% and 58%, respectively, to the dryer fraction. The combination of faecal separation and urine diversion in the house Ekoporten made it possible to collect 60% of N, 46% of P and 43% of K from the wastewater, indicating that this method is an alternative when aiming to recover plant nutrients while still wanting to use water-flushed, urine-diverting toilets, though the potential to collect the nutrients is much higher.

Agriculture↗

PubMed2003

Thermal composting of faecal matter as treatment and possible disinfection method--laboratory-scale and pilot-scale studies.

When using toilets where the urine and faeces are collected separately for reuse as nutrients in agriculture, the collected matter should be disinfected. One way to do this is by thermal composting. Composting of different material mixes was investigated in a laboratory-scale experiment. This showed that the best mixture for dry thermal composting was a mix of faeces, food waste and amendment. The urine was collected separately by use of urine-diverting toilets. A new method was developed to mathematically evaluate and estimate the safety margins of pathogen inactivation during thermal composting. The method is based upon a mathematical calculation of the number of times total inactivation (at least 12log(10) reduction) of the organisms is achieved. In a pilot-scale experiment, the disinfection of a faeces/food waste mix was performed with a calculated safety margin of more than 37 times the total die-off of Enteroviruses and some 550 times that of Ascaris. Thus, well functioning composting seems to be effective for disinfection of faecal matter. To get a high temperature in all of the material, the reactor has to have sufficient insulation. A major disadvantage is the initial need for handling the raw un-disinfected material. The degradation of the organic matter in the compost was almost 75%, resulting in a small final volume that could safely be recycled.

Animals↗

PubMed1996

Prompted voiding in the long-term care facility.

Approximately 50% of residents in United States long-term care facilities are incontinent of urine. Federal regulations require nursing facilities to move away from caring for incontinent residents in a custodial fashion and toward a rehabilitative model. Prompted voiding is one technique that has been thoroughly tested in long-term care facilities and found to significantly improve continence among residents. Provision of prompted voiding is labor intensive, and its application in long-term care facilities requires that management systems be in place to develop and maintain staff participation in the program.

Behavior Therapy↗

PubMed1999

Staff compliance with and ratings of effectiveness of a prompted voiding program in a long-term care facility.

BACKGROUND: Despite findings that prompted voiding is effective in reducing urinary incontinent (UI) episodes, the prevalence of UI in this population has remained unchanged. It is estimated that 50% of all nursing home residents have UI. Staff involvement is considered a critical factor, yet little is known about staff perception of the effectiveness of prompted voiding. METHODS: This descriptive study of staff perceptions of a prompted voiding intervention was conducted at a university-affiliated 255-bed geriatrics center. A 12-week prompted voiding program was conducted with 17 residents with UI. Baseline continence status was compared with continence status at the end of the program, and a survey was conducted to assess staff perceptions of the program. The aims of the study were: (1) to determine effectiveness of a prompted voiding program, (2) to assess staff perception of overall effectiveness of the prompted voiding program, (3) to assess staff compliance with the prompted voiding program, and (4) to compare staff perception of prompted voiding effectiveness with actual continence outcomes. RESULTS: Overall UI status improved in 5 residents (31%), remained the same in 6 residents (38%), and declined in 5 residents (31%). Sixty-four (73%) of 88 staff members who participated in the program responded to a survey. Staff members were asked to rate their overall impressions of the prompted voiding program, and to rate improvement in continence status for specific residents who participated in the program. Ninety-five percent of staff members thought drier residents were happier; 80% thought the prompted voiding program should continue. Only 52% of staff thought residents participating in the prompted voiding program were better, and 43% perceived no change. A majority (58%) of staff thought compliance with prompted voiding was 80% to 90%; however, unobtrusive observations during the study revealed only 70% compliance. There was no correlation between staff ratings of improvement in continence and actual continence outcomes for individual residents (r = 0.02, P = .709). CONCLUSIONS: Staff reports of compliance with a prompted voiding program were inflated, and they were unable to determine which residents had actually improved and which residents had not improved with regard to UI. These findings suggest that nursing home staff, and particularly nursing assistants, need more meaningful definitions of UI and quantifiable evidence that residents benefit from prompted voiding.

Adult↗

PubMed2001

A study of risk factors for intestinal helminth infections using epidemiological and anthropological approaches.

This study. conducted in Kisumu District, Kenya, identified important risk factors for infection with intestinal helminths using traditional epidemiological methods. This was combined with a rapid assessment study using qualitative methods, which focused on sanitation practices and local illness perceptions. The multiple logistic regression analysis revealed that the absence of latrines was a significant predictor for hookworm infection with an odds ratio (OR) of 1.9. The analysis also revealed that households without soap had a 2.6 times higher risk of being infected with Ascaris lumbricoides compared with households where soap was available, and that the number of inhabitants living in a household was a significant predictor for infections with hookworms (OR=3.2). Furthermore, the presence of children of 5 years and under in the household was a predictor for infection with A. lumbricoides (OR=2.7), while the absence of this age group was a predictor for hookworm infection (OR=3.8). The qualitative part of the study revealed that people did not consider worms as a serious health threat, but as a nuisance. Among the population. latrines were seen as beneficial because they were believed to prevent disease, to provide privacy and to keep the environment free of faeces. Handwashing was done many times a day but usually not with soap, which was mainly used when bathing or washing the whole body. Many inhabitants in a household or the presence of children of 5 years and under were never mentioned as being a disadvantage, and these elements would therefore be difficult to include in a control strategy. Since the lack of latrines and of soap were identified as risk factors for infection, while latrines, soap and medicine were seen as assets by the population, it is suggested that helminth control interventions should be concentrated within these areas in this particular society.

Age Distribution↗

PubMed1976

Coated bedpans: their cleaning and disinfection.

This paper reports on tests of cleaning and disinfection of stainless steel bedpans which have been coated with either a silicone grease or polytetrafluoroethylene (PTFE). The coatings were applied manually using an aerosol spray (silicone grease and PTFE), and by an industrial process (PTFE). Soils used comprised (i) British Standard Soil (B.S., 1966), (ii) human serum albumin labelled with technetium-99m (HSA-Tc), and (iii) a suspension of Streptococcus faecalis in broth. Tests of cleaning and disinfection were carried out in automatic washing and steam disinfector machines. Results show that aerosol spraying impairs the cleaning process but that bedpans coated by the industrial process with PTFE are superior to uncoated bedpans.

Disinfection↗

PubMed1980

A method for measuring the cleaning effect of flushing disinfectors.

A method is presented with which the mechanical cleaning effect of flushing disinfectors can be estimated independently of the thermal disinfecting effect of the hot flushing water. This makes it possible to specify the demands to be placed on the disinfecting effect of flushing with water of 85 degrees C or more. Bacillus stearothermophilus spores suspended in faeces were used as indicators because of their non-sensitivity to the hot-water temperature. Their elimination by flushing could thus be attributed to the mechanical effect of the water and not to the disinfecting effect of the temperature. A simple bacteriological technique was used, and the elimination factor (EF) was calculated as the ratio of the number of micro-organisms in the contamination before and after flushing. By using flushing water below 50 degrees C for 130 s the EF on a bedpan was about 10(4)-10(6). The effect of flushing with water of the same temperature for only half that time was somewhat weaker and when the temperature was raised to 85 degrees C after half the flushing time the effect was somewhat stronger. It can be presumed that the conventional disinfecting phase with hot (85 degrees C) water for about 45 s in the commonly used flushing units could be substantially shortened and the costs of their use thereby reduced.

Disinfection↗

PubMed1983

Studies on well water and possible health risks in Katsina, Nigeria.

Well water was sampled from all four major wards in Katsina town. All 20 samples taken showed high coliform counts. Sixty-five per cent contained greater than or equal to 2400 coliforms per 100 ml while the remainder had counts ranging from 79 to 920. Faecal coliforms and non-cholera vibrios were detected in all samples. There was no significant relationship between the coliform counts and the distances of latrines to wells, water table to ground level, slope relationship between wells and latrines, the pH of water and whether the wells were left permanently open or not. Salmonella sp., Enterobacter sp. and Pseudomonas sp. were each isolated from about 10% of the samples, while Proteus sp. was isolated from 40%, Citrobacter sp. 15%, Alcaligenes sp. 5% and an unidentified Gram-negative rod from 5%. Only 2 (10%) of the sampled households, representing 23 (9.6%) of the 239 people exposed to well-water had pipeborne water in addition. It was concluded that well water in Katsina town could be a human health hazard.

Bacteria↗

PubMed1973

Sonne dysentery in day schools and nurseries: an eighteen-year study in Edmonton.

A study of Sonne dysentery infections in 19 primary and 11 secondary day-schools and 4 day-nurseries has been made over a period of 18 years in an urban area. Measures were taken throughout to try to prevent and control outbreaks. Sonne dysentery was not endemic in the school population and, even at times of high incidence, epidemics were localized within a few of the primary schools, usually in the spring or autumn terms. Incidence rates of Sonne dysentery were highest in primary schools with large infant departments and in nurseries. Secondary schools entirely escaped outbreaks.The co-operation of head teachers was engaged for all precautionary measures in schools. A policy of immediate exclusion of suspected and infected children was useful in preventing and controlling school epidemics of dysentery. Toilet hygiene was often poor in schools with outbreaks, and this was found to be a profitable field for applying control measures. Infected kitchen workers were only occasionally involved.Recommendations are given in the light of this study, and some reference is made to the more difficult problem posed by dysentery outbreaks in day-nurseries, where temporary closure may be the best policy. It is important that responsibility for infectious disease control in schools be clearly delineated in the reorganized health services of 1974. Teachers can play an important part in limiting infection.

Adolescent↗

PubMed1976

A bacteriological survey of washrooms and toilets.

A survey of the bacterial flora present at various positions in 130 male and female washrooms and toilets is reported. Several bacteria of faecal origin were found in large numbers: the areas likely to be the most important sources of cross-infection from faecal contamination are indicated. The results are used to assess priorities for disinfection.

Bacteria↗

PubMed1972

Chemical closet treatment of typhoid carrier faeces.

An investigation to test the efficiency of chemical closets in treating excreta from typhoid carriers is described. The use of these closets kept a stream, which had in the past frequently contained Salmonella typhi, typhoid free for 24 months. Selenite broth as made in this laboratory, containing a final concentration of 0.8% sodium hydrogen selenite when inoculated with the water sample, was significantly better than commercial selenite brilliant green enrichment broth for the recovery of S. typhi.

Carrier State↗

PubMed1984

Evaluation of disinfectants in the domestic environment under 'in use' conditions.

An 'in use' test was developed to investigate effectiveness of disinfectant application and of detergent of hot water cleaning at kitchen, bathroom and toilet sites in the domestic environment. Detergent and hot water cleaning produced no observable reduction in microbial contamination. Single and daily application tests demonstrated that hypochlorite and phenolic disinfectants can be used to produce substantial reductions in bacterial contamination in the home. Results indicate that maximum protection afforded by disinfection is relatively brief; 3-6 h after disinfection, contamination levels were only marginally less than those observed at pretreatment. Some suggestions are made for improvements in home hygiene.

Bedding and Linens↗

PubMed1993

Field trials in the control of Opisthorchis viverrini with an integrated programme in endemic areas of northeast Thailand.

A control programme of opisthorchiasis was carried out for three years in three villages of northeast Thailand in order to compare the effectiveness of two intervention measures. The intervention measures employed were to give praziquantel treatment to all infected people either once (village I) or twice (village II) per year with the integration of regular health education and sanitation improvement. A control village (village III) received no intervention during the study. Sampling of the population in these villages to estimate prevalence, intensity, reinfection and incidence of infection as well as knowledge of opisthorchiasis and number of latrines was performed at 6 monthly intervals throughout the duration of the study. At the initial assessment, there were no significant differences in the prevalence and intensity of infection of villages I and II. Both values were greatly reduced when assessed 6 months after the initiation of treatment, and the decrease in prevalence and intensity of infection did not differ between village I and II. The control village (village III), during the first 2 years, exhibited slight variation in the prevalence and intensity, and these decreased considerably in the third year of the study. The reinfection rate per 6 months in villages I and II was nearly equal. The incidence rate per 6 months in the two treated villages was lower than that of the control village. Marked improvement in knowledge of opisthorchiasis, behavioural changes of eating raw fish and increased numbers of latrines was evident in all of the villages during this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1989

Genotyping of Pseudomonas aeruginosa sputum and stool isolates from cystic fibrosis patients: evidence for intestinal colonization and spreading into toilets.

Three hundred and fifty-eight stool and 131 sputum specimens from 40 cystic fibrosis (CF) patients and 100 toilet sinks were investigated for occurrence of Pseudomonas aeruginosa; 67% (21/31) of the patients with chronic P. aeruginosa lung infections carried the organism repeatedly in the stool but the organism was found only once in the stools of nine uninfected patients. P. aeruginosa stool carriage was correlated to high P. aeruginosa numbers in patients' sputa. Typing of P. aeruginosa with a DNA probe showed identity of sputum and stool strains. Seven patients repeatedly carried additional stool strains, not found in the sputum, suggesting intestinal colonization. No differences were seen in the clinical state of patients with P. aeruginosa-negative stool samples and patients with positive stool samples. Toilets in households of P. aeruginosa-infected CF patients were significantly more often contaminated with P. aeruginosa (42%) than toilets in households of non-infected CF patients (20%; P less than 0.03). The study shows that P. aeruginosa-infected CF patients may harbour the organisms also in the intestinal tract, and may spread the bacteria into toilets.

Adolescent↗

PubMed2001

Salinity effect on mechanical dewatering of sludge with and without chemical conditioning.

The salinity levels of wastewater and sludge are relatively high in some coastal cities as they may use saline water for toilet flushing, and as such,the sludge dewaterability can be affected by it. The salinity effect on sludge dewaterability was therefore investigated through experimental testing of specific resistance in filtration (SRF), time to filter (TTF), and final solid content of sludge. SRF and TTF were determined using Buchner funnel tests. The final solid content was estimated by centrifuging the sludge at four levels of rotational speed. Sludge with three salinity levels (5,000, 10,000 and 20,000 ppm) were considered in this study. Coagulants such as alum, iron(II) sulfate, and organic polyelectrolytes were added to the sludgetostudythe dewaterability of such sludge with chemical conditioning. Experimental results show that doubling the salinity level of the sludge from 10,000 to 20,000 ppm shows not much change in SRF and TTF. Compared with the sludge without chemical conditioning, the addition of the coagulants to the sludge at a salinity level of 5,000 ppm drastically reduces its SRF and TTF. However, sludge with and without chemical conditioning at a salinity of 20,000 ppm has similar SRF and TTF. The final solid content of sludge increases almost linearly with salinity. Among the coagulants used in this study, the cationic polyelectrolyte is found to be better in improving sludge dewaterability, while iron(II) sulfate performs slightly better in enhancing the final solid content of the sludge.

Particle Size↗

PubMed2006

Considering user attitude in early Development of environmentally friendly technology: a case study of NoMix toilets.

Urine source separation (NoMix technology) has been proposed as a sustainable alternative to centralized wastewater treatment systems. Radical changes necessitate an early inclusion of sociological expertise, thus offering a real chance fortransdisciplinary collaboration. The practical aim of our survey is to find out how users accept and use existing NoMixtoilets and how this could be encouraged. We collected 1249 questionnaires from 2002 to 2004 in one Swiss school and one Swiss research institute. The technological immaturity of NoMix toilets was noted by many. Nevertheless, acceptance was high: 72% liked the idea and 86% would move into apartments with NoMix toilets. Moreover, most users found that NoMix toilets equal conventional toilets with respect to design (78%), hygiene (84%), and smell (78%). Like many other innovations, the NoMix technology only functions properly if it is used adequately, which we demonstrate for water saving and sitting to urinate. Many users adopted this behavior, e.g., 72% sat. Because perception and use of NoMix toilets is subjective, it can be influenced with certain measures such as good information and cleaning, or discussions with peers. We discuss the importance of social psychology for understanding the factors that influence the acceptance of environmentally friendly innovations.

Attitude↗

PubMed1998

An outbreak of intrafamiliar hepatitis A associated with clam consumption: epidemic transmission to a school community.

An outbreak of hepatitis A is described involving thirteen cases in a town in central-northern Italy. The consumption of infected clams, caught in a polluted coastal area of the Adriatic Sea, caused hepatitis A in all five members of a family consisting of mother, father and children, two of whom attended primary school. The epidemic subsequently spread to the primary school with a secondary attack rate of 7.9%, 0 for female pupils and 18.9% for males. The epidemiological and environmental investigations showed that the critical exposure took place in the boys' toilet in the primary school (OR: 32.79, 95% CI: 6.83-157.45). To prevent the spreading of contagion, extra disinfection was carried out in the whole school and health education campaigns were mounted. The good basic hygienic conditions of the homes, together with the cooperation of school staff in surveillance and providing information, allowed the epidemic to be controlled.

Adolescent↗